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The management of chronic venous insufficiency with ulceration: the role of minimally invasive perforator interruption.
Ann Vasc Surg. 2013 Jan; 27(1):89-95.AV

Abstract

BACKGROUND

The purpose of this study was to analyze the long-term outcomes associated with interruption of incompetent perforator veins (IPV) using minimally invasive techniques as adjunctive therapies in the management of patients with chronic venous insufficiency (CVI).

METHODS

This is a retrospective review of a prospectively maintained venous database collected over 6 years (2005-2011). The study cohort included 64 patients with CVI stage C5 or C6 who underwent minimally invasive perforator interruption with subfascial endoscopic perforator surgery (SEPS) or radiofrequency ablation of IPV (RFA-IPV) as part of the management of their CVI. All patients were referred for evaluation after having failed conservative treatment with compression dressings. Relevant patient characteristics and comorbidities were recorded along with symptom resolution, venous ulcer healing, recurrence, and surgical complications. In addition to clinic follow-up examination by a surgical provider, chart notes from other subspecialties were also reviewed. We also conducted telephone assessments in patients who had been lost to clinic follow-up in order to provide complete outcome data.

RESULTS

In this subset (n = 64) of patients with CVI who had adjunctive IPV treatment, 41 (64%) underwent SEPS and 23 (36%) patients underwent RFA-IPV along with ablation of the greater saphenous vein for C5 or C6 disease. The mean patient follow-up was 37 months. There were no differences in patient demographics or risk factors. Twenty-three (88%) SEPS and 12 (100%) RFA-IPV patients (P = NS) with C6 disease went on to completely heal their venous ulcers after the procedure with an average healing time of 5.2 (SEPS) and 4.4 (RFA-IPV) months (P = NS). Overall, 7 (17%) SEPS and 6 (23%) RFA-IPV patients (P = NS) developed a recurrent ulcer after surgical treatment. Procedural complications were seen in 14 (34%) SEPS and 2 (9%) RFA-IPV patients (P = NS), mostly minor. Major complications only occurred in the SEPS group consisting of 2 major amputations caused by pain from nonhealing ulcers and 1 deep venous thrombosis.

CONCLUSIONS

This study supports the premise that in patients with advanced venous disease, there may be a demonstrable benefit directly attributable to perforator interruption. Our recurrent ulceration rates are acceptable, with low complication rates in patients undergoing RFA-IPV, thereby making this procedure more attractive in patients with multiple comorbidities. We support an aggressive approach to patients with C5/C6 disease that includes perforator elimination when appropriate.

Authors+Show Affiliations

Division of Vascular Surgery, Scott and White Healthcare and Central Texas Veterans Healthcare System, Texas A&M College of Medicine, Temple, TX 76534, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23257074

Citation

Rueda, Carlos A., et al. "The Management of Chronic Venous Insufficiency With Ulceration: the Role of Minimally Invasive Perforator Interruption." Annals of Vascular Surgery, vol. 27, no. 1, 2013, pp. 89-95.
Rueda CA, Bittenbinder EN, Buckley CJ, et al. The management of chronic venous insufficiency with ulceration: the role of minimally invasive perforator interruption. Ann Vasc Surg. 2013;27(1):89-95.
Rueda, C. A., Bittenbinder, E. N., Buckley, C. J., Bohannon, W. T., Atkins, M. D., & Bush, R. L. (2013). The management of chronic venous insufficiency with ulceration: the role of minimally invasive perforator interruption. Annals of Vascular Surgery, 27(1), 89-95. https://doi.org/10.1016/j.avsg.2012.09.001
Rueda CA, et al. The Management of Chronic Venous Insufficiency With Ulceration: the Role of Minimally Invasive Perforator Interruption. Ann Vasc Surg. 2013;27(1):89-95. PubMed PMID: 23257074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The management of chronic venous insufficiency with ulceration: the role of minimally invasive perforator interruption. AU - Rueda,Carlos A, AU - Bittenbinder,Emilia N, AU - Buckley,Clifford J, AU - Bohannon,William T, AU - Atkins,Marvin D, AU - Bush,Ruth L, PY - 2012/04/17/received PY - 2012/08/18/revised PY - 2012/09/05/accepted PY - 2012/12/22/entrez PY - 2012/12/22/pubmed PY - 2013/6/1/medline SP - 89 EP - 95 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 27 IS - 1 N2 - BACKGROUND: The purpose of this study was to analyze the long-term outcomes associated with interruption of incompetent perforator veins (IPV) using minimally invasive techniques as adjunctive therapies in the management of patients with chronic venous insufficiency (CVI). METHODS: This is a retrospective review of a prospectively maintained venous database collected over 6 years (2005-2011). The study cohort included 64 patients with CVI stage C5 or C6 who underwent minimally invasive perforator interruption with subfascial endoscopic perforator surgery (SEPS) or radiofrequency ablation of IPV (RFA-IPV) as part of the management of their CVI. All patients were referred for evaluation after having failed conservative treatment with compression dressings. Relevant patient characteristics and comorbidities were recorded along with symptom resolution, venous ulcer healing, recurrence, and surgical complications. In addition to clinic follow-up examination by a surgical provider, chart notes from other subspecialties were also reviewed. We also conducted telephone assessments in patients who had been lost to clinic follow-up in order to provide complete outcome data. RESULTS: In this subset (n = 64) of patients with CVI who had adjunctive IPV treatment, 41 (64%) underwent SEPS and 23 (36%) patients underwent RFA-IPV along with ablation of the greater saphenous vein for C5 or C6 disease. The mean patient follow-up was 37 months. There were no differences in patient demographics or risk factors. Twenty-three (88%) SEPS and 12 (100%) RFA-IPV patients (P = NS) with C6 disease went on to completely heal their venous ulcers after the procedure with an average healing time of 5.2 (SEPS) and 4.4 (RFA-IPV) months (P = NS). Overall, 7 (17%) SEPS and 6 (23%) RFA-IPV patients (P = NS) developed a recurrent ulcer after surgical treatment. Procedural complications were seen in 14 (34%) SEPS and 2 (9%) RFA-IPV patients (P = NS), mostly minor. Major complications only occurred in the SEPS group consisting of 2 major amputations caused by pain from nonhealing ulcers and 1 deep venous thrombosis. CONCLUSIONS: This study supports the premise that in patients with advanced venous disease, there may be a demonstrable benefit directly attributable to perforator interruption. Our recurrent ulceration rates are acceptable, with low complication rates in patients undergoing RFA-IPV, thereby making this procedure more attractive in patients with multiple comorbidities. We support an aggressive approach to patients with C5/C6 disease that includes perforator elimination when appropriate. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/23257074/The_management_of_chronic_venous_insufficiency_with_ulceration:_the_role_of_minimally_invasive_perforator_interruption_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00425-6 DB - PRIME DP - Unbound Medicine ER -